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Corsello A, Marangoni MB, Macchi M, Cozzi L, Agostoni C, Milani GP, Dilena R. Febrile Seizures: A Systematic Review of Different Guidelines. Pediatr Neurol 2024; 155:141-148. [PMID: 38653182 DOI: 10.1016/j.pediatrneurol.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Febrile seizures (FS) are the most common neurological disorder in pediatric age. FS affect 2% to 12% of children and result from a complex interplay of genetic and environmental factors. Effective management and unambiguous recommendations are crucial for allocating health care resources efficiently and ensuring cost-effectiveness in treating FS. METHODS This systematic review compares existing guidelines to provide insights into FS management. Seven guidelines published between 1991 and 2021, from Japan, United Kingdom, United States, Mexico, India, and Italy, were included. Data extraction covered definitions, diagnostic criteria, hospital admission criteria, diagnostic tests, management, and prophylaxis recommendations. RESULTS Hospital admission criteria varied but typically included age <18 months and complex FS. Neuroimaging and lumbar puncture recommendations varied, with most guidelines suggesting limited use. Pharmacologic prophylaxis was generally discouraged for simple FS but considered only for high-risk cases, due to the benign nature of FS and the potential side effects of antiseizure medications. CONCLUSIONS Guidelines on FS exhibit similarities and differences, highlighting the need for standardized management and improved parental education to enhance clinical outcomes and reduce economic and social costs associated with FS. Future research should focus on creating updated international guidelines and ensuring their practical implementation.
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Affiliation(s)
- Antonio Corsello
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | | | - Marina Macchi
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Laura Cozzi
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy; Struttura Complessa Pediatria, Presidio Ospedaliero Magenta, ASST Ovest Milanese, Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Unit, Milan, Italy
| | - Gregorio Paolo Milani
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Unit, Milan, Italy
| | - Robertino Dilena
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuropathophysiology Unit, Milan, Italy.
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2
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Lewis DV, Voyvodic J, Shinnar S, Chan S, Bello JA, Moshé SL, Nordli DR, Frank LM, Pellock JM, Hesdorffer DC, Xu Y, Shinnar RC, Seinfeld S, Epstein LG, Masur D, Gallentine W, Weiss E, Deng X, Sun S. Hippocampal sclerosis and temporal lobe epilepsy following febrile status epilepticus: The FEBSTAT study. Epilepsia 2024; 65:1568-1580. [PMID: 38606600 PMCID: PMC11166525 DOI: 10.1111/epi.17979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE This study was undertaken to determine whether hippocampal T2 hyperintensity predicts sequelae of febrile status epilepticus, including hippocampal atrophy, sclerosis, and mesial temporal lobe epilepsy. METHODS Acute magnetic resonance imaging (MRI) was obtained within a mean of 4.4 (SD = 5.5, median = 2.0) days after febrile status on >200 infants with follow-up MRI at approximately 1, 5, and 10 years. Hippocampal size, morphology, and T2 signal intensity were scored visually by neuroradiologists blinded to clinical details. Hippocampal volumetry provided quantitative measurement. Upon the occurrence of two or more unprovoked seizures, subjects were reassessed for epilepsy. Hippocampal volumes were normalized using total brain volumes. RESULTS Fourteen of 22 subjects with acute hippocampal T2 hyperintensity returned for follow-up MRI, and 10 developed definite hippocampal sclerosis, which persisted through the 10-year follow-up. Hippocampi appearing normal initially remained normal on visual inspection. However, in subjects with normal-appearing hippocampi, volumetrics indicated that male, but not female, hippocampi were smaller than controls, but increasing hippocampal asymmetry was not seen following febrile status. Forty-four subjects developed epilepsy; six developed mesial temporal lobe epilepsy and, of the six, two had definite, two had equivocal, and two had no hippocampal sclerosis. Only one subject developed mesial temporal epilepsy without initial hyperintensity, and that subject had hippocampal malrotation. Ten-year cumulative incidence of all types of epilepsy, including mesial temporal epilepsy, was highest in subjects with initial T2 hyperintensity and lowest in those with normal signal and no other brain abnormalities. SIGNIFICANCE Hippocampal T2 hyperintensity following febrile status epilepticus predicted hippocampal sclerosis and significant likelihood of mesial temporal lobe epilepsy. Normal hippocampal appearance in the acute postictal MRI was followed by maintained normal appearance, symmetric growth, and lower risk of epilepsy. Volumetric measurement detected mildly decreased hippocampal volume in males with febrile status.
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Affiliation(s)
- Darrell V. Lewis
- Department of Pediatrics (Neurology), Duke University Medical Center, Durham, NC
| | - James Voyvodic
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Shlomo Shinnar
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology and Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Stephen Chan
- Department of Radiology, Harlem Hospital Center, Columbia University, New York, NY
| | - Jacqueline A. Bello
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Solomon L. Moshé
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology and Departments of Neuroscience and Pediatrics, Albert Einstein College of Medicine, and Montefiore Medical Center, Bronx, NY
| | - Douglas R. Nordli
- Department of Pediatrics, Section of Child Neurology, University of Chicago, Chicago, IL
| | - L. Matthew Frank
- Department of Neurology, Children’s Hospital of the King’s Daughters and Eastern Virginia Medical School, Norfolk, VA
| | - John M. Pellock
- Department of Neurology, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA
| | - Dale C. Hesdorffer
- Department of Epidemiology, G. H. Sergievsky Center, Columbia University, New York, NY
| | - Yuan Xu
- Department of Pediatrics (Neurology), Duke University Medical Center, Durham, NC
| | - Ruth C. Shinnar
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology and Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Syndi Seinfeld
- Pediatric Epilepsy Program, Joe DiMaggio Children’s Hospital, Hollywood, FL
| | - Leon G. Epstein
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - David Masur
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | | | - Erica Weiss
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Xiaoyan Deng
- Biostatistics and International Epilepsy Consortium, Virginia Commonwealth University, Richmond, VA
| | - Shumei Sun
- Biostatistics and International Epilepsy Consortium, Virginia Commonwealth University, Richmond, VA
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3
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Scott RC, Moshé SL, Holmes GL. Do vaccines cause epilepsy? Review of cases in the National Vaccine Injury Compensation Program. Epilepsia 2024; 65:293-321. [PMID: 37914395 DOI: 10.1111/epi.17794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE The National Childhood Vaccine Injury Act of 1986 created the National Vaccine Injury Compensation Program (VICP), a no-fault alternative to the traditional tort system. Since 1988, the total compensation paid exceeds $5 billion. Although epilepsy is one of the leading reasons for filing a claim, there has been no review of the process and validity of the legal outcomes given current medical information. The objectives were to review the evolution of the VICP program in regard to vaccine-related epilepsy and assess the rationale behind decisions made by the court. METHODS Publicly available cases involving epilepsy claims in the VICP were searched through Westlaw and the US Court of Federal Claims websites. All published reports were reviewed for petitioner's theories supporting vaccine-induced epilepsy, respondent's counterarguments, the final decision regarding compensation, and the rationale underlying these decisions. The primary goal was to determine which factors went into decisions regarding whether vaccines caused epilepsy. RESULTS Since the first epilepsy case in 1989, there have been many changes in the program, including the removal of residual seizure disorder as a vaccine-related injury, publication of the Althen prongs, release of the acellular form of pertussis, and recognition that in genetic conditions the underlying genetic abnormality rather than the immunization causes epilepsy. We identified 532 unique cases with epilepsy: 105 with infantile spasms and 427 with epilepsy without infantile spasms. The petitioners' experts often espoused outdated, erroneous causation theories that lacked an acceptable medical or scientific foundation and were frequently criticized by the court. SIGNIFICANCE Despite the lack of epidemiological or mechanistic evidence indicating that childhood vaccines covered by the VICP result in or aggravate epilepsy, these cases continue to be adjudicated. After 35 years of intense litigation, it is time to reconsider whether epilepsy should continue to be a compensable vaccine-induced injury.
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Affiliation(s)
- Rodney C Scott
- Nemours Children's Hospital-Delaware, Wilmington, Delaware, USA
| | - Solomon L Moshé
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Gregory L Holmes
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
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Yi Y, Zhong C, Wei-wei H. The long-term neurodevelopmental outcomes of febrile seizures and underlying mechanisms. Front Cell Dev Biol 2023; 11:1186050. [PMID: 37305674 PMCID: PMC10248510 DOI: 10.3389/fcell.2023.1186050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023] Open
Abstract
Febrile seizures (FSs) are convulsions caused by a sudden increase in body temperature during a fever. FSs are one of the commonest presentations in young children, occurring in up to 4% of children between the ages of about 6 months and 5 years old. FSs not only endanger children's health, cause panic and anxiety to families, but also have many adverse consequences. Both clinical and animal studies show that FSs have detrimental effects on neurodevelopment, that cause attention deficit hyperactivity disorder (ADHD), increased susceptibility to epilepsy, hippocampal sclerosis and cognitive decline during adulthood. However, the mechanisms of FSs in developmental abnormalities and disease occurrence during adulthood have not been determined. This article provides an overview of the association of FSs with neurodevelopmental outcomes, outlining both the underlying mechanisms and the possible appropriate clinical biomarkers, from histological changes to cellular molecular mechanisms. The hippocampus is the brain region most significantly altered after FSs, but the motor cortex and subcortical white matter may also be involved in the development disorders induced by FSs. The occurrence of multiple diseases after FSs may share common mechanisms, and the long-term role of inflammation and γ-aminobutyric acid (GABA) system are currently well studied.
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Affiliation(s)
- You Yi
- Department of Pharmacology and Department of Pharmacy of the Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang University School of Medicine, Hangzhou, China
| | - Chen Zhong
- Department of Pharmacology and Department of Pharmacy of the Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, China
| | - Hu Wei-wei
- Department of Pharmacology and Department of Pharmacy of the Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang University School of Medicine, Hangzhou, China
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5
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Bosque Varela P, Machegger L, Oellerer A, Steinbacher J, McCoy M, Pfaff J, Trinka E, Kuchukhidze G. Imaging of status epilepticus: Making the invisible visible. A prospective study on 206 patients. Epilepsy Behav 2023; 141:109130. [PMID: 36803874 DOI: 10.1016/j.yebeh.2023.109130] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Peri-ictal MRI abnormalities (PMA) frequently affect the cerebral cortex, hippocampus, pulvinar of the thalamus, corpus callosum, and cerebellum. In this prospective study, we aimed to characterize the spectrum of PMA in a large cohort of patients with status epilepticus. METHODS We prospectively recruited 206 patients with SE and an acute MRI. The MRI protocol included diffusion weighted imaging (DWI), fluid-attenuated inversion recovery (FLAIR), arterial spin labeling (ASL), and T1-weighted imaging pre-and post-contrast application. Peri-ictal MRI abnormalities were stratified as either neocortical or non-neocortical. Amygdala, hippocampus, cerebellum, and corpus callosum were regarded as non-neocortical structures. RESULTS Peri-ictal MRI abnormalities were observed in 93/206 (45%) of patients in at least one MRI sequence. Diffusion restriction was observed in 56/206 (27%) of patients, which was mainly unilateral in 42/56 (75%) affecting neocortical structures in 25/56 (45%), non-neocortical structures in 20/56 (36%) and both areas in 11/56 (19%) of patients. Cortical DWI lesions were located mostly in frontal lobes 15/25 (60%); non-neocortical diffusion restriction affected either the pulvinar of the thalamus or hippocampus 29/31 (95%). Alterations in FLAIR were observed in 37/203 (18%) of patients. They were mainly unilateral 24/37 (65%); neocortical 18/37 (49%), non-neocortical 16/37 (43%), or affecting both neocortical and non-neocortical structures 3/37 (8%). In ASL, 51/140 (37%) of patients had ictal hyperperfusion. Hyperperfused areas were located mainly in the neocortex 45/51 (88%) and were unilateral 43/51 (84%). In 39/66 (59%) of patients, PMA were reversible in one week. In 27/66 (41%), the PMA persisted and a second follow-up MRI was performed three weeks later in 24/27 (89%) patients. In 19/24 (79%) PMA were resolved. CONCLUSIONS Almost half of the patients with SE had peri-ictal MRI abnormalities. The most prevalent PMA was ictal hyperperfusion followed by diffusion restriction and FLAIR abnormalities. Neocortex was most frequently affected especially the frontal lobes. The majority of PMAs were unilateral. This paper was presented at the 8th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in September 2022.
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Affiliation(s)
- Pilar Bosque Varela
- Department of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, and Centre for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Austria
| | - Lukas Machegger
- Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Austria
| | - Andreas Oellerer
- Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Austria
| | - Jürgen Steinbacher
- Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Austria
| | - Mark McCoy
- Department of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, and Centre for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Austria; Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria
| | - Johannes Pfaff
- Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, and Centre for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Austria; Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria; Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, and Centre for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Austria; Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria.
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6
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Liang C, Chu E, Kuoy E, Soun JE. Autoimmune-mediated encephalitis and mimics: A neuroimaging review. J Neuroimaging 2023; 33:19-34. [PMID: 36217010 DOI: 10.1111/jon.13060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/10/2022] [Accepted: 09/20/2022] [Indexed: 02/01/2023] Open
Abstract
Autoimmune encephalitis is a category of autoantibody-mediated neurological disorders that often presents a diagnostic challenge due to its variable clinical and imaging findings. The purpose of this image-based review is to provide an overview of the major subtypes of autoimmune encephalitis and their associated autoantibodies, discuss their characteristic clinical and imaging features, and highlight several disease processes that may mimic imaging findings of autoimmune encephalitis. A literature search on autoimmune encephalitis was performed and publications from neuroradiology, neurology, and nuclear medicine literature were included. Cases from our institutional database that best exemplify major imaging features were presented.
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Affiliation(s)
- Conan Liang
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, California, USA
| | - Eleanor Chu
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, California, USA
| | - Edward Kuoy
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, California, USA
| | - Jennifer E Soun
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, California, USA
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7
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Eilbert W, Chan C. Febrile seizures: A review. J Am Coll Emerg Physicians Open 2022; 3:e12769. [PMID: 36016968 PMCID: PMC9396974 DOI: 10.1002/emp2.12769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 01/23/2023] Open
Abstract
Febrile seizures are common, occurring in up to 5% of children in the United States. Frequently perceived by caregivers as a life‐threatening event, febrile seizures are a common cause of emergency department visits. The concern for permanent neurologic sequelae and future epilepsy after febrile seizures has resulted in a significant amount of research on these topics. The development of childhood vaccines over the past several decades has led to a significant reduction in childhood bacterial meningitis. This in turn has led to a dramatic change in the evaluation and treatment of febrile seizures. In this review, the different types of febrile seizures as well as the evaluation and prognosis of each are discussed.
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Affiliation(s)
- Wesley Eilbert
- Department of Emergency Medicine College of Medicine University of Illinois at Chicago Chicago Illinois USA
| | - Chuck Chan
- Department of Emergency Medicine College of Medicine University of Illinois at Chicago Chicago Illinois USA
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8
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Harris SA, George AG, Barrett KT, Scantlebury MH, Teskey GC. Febrile seizures lead to prolonged epileptiform activity and hyperoxia that when blocked prevents learning deficits. Epilepsia 2022; 63:2650-2663. [DOI: 10.1111/epi.17371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/31/2022] [Accepted: 07/18/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Sydney A. Harris
- Hotchkiss Brain Institute University of Calgary Calgary AB Canada
- Alberta Children’s Hospital Research Institute University of Calgary Calgary AB Canada
| | - Antis G. George
- Hotchkiss Brain Institute University of Calgary Calgary AB Canada
| | - Karlene T. Barrett
- Hotchkiss Brain Institute University of Calgary Calgary AB Canada
- Alberta Children’s Hospital Research Institute University of Calgary Calgary AB Canada
- Departments of Pediatrics and Clinical Neurosciences University of Calgary Calgary AB Canada
| | - Morris H. Scantlebury
- Hotchkiss Brain Institute University of Calgary Calgary AB Canada
- Alberta Children’s Hospital Research Institute University of Calgary Calgary AB Canada
- Departments of Pediatrics and Clinical Neurosciences University of Calgary Calgary AB Canada
| | - G. Campbell Teskey
- Hotchkiss Brain Institute University of Calgary Calgary AB Canada
- Alberta Children’s Hospital Research Institute University of Calgary Calgary AB Canada
- Department of Cell Biology and Anatomy University of Calgary Calgary AB Canada
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Peng SJ, Hsieh KLC, Lin YK, Tsai ML, Wong TT, Chang H. Febrile seizures reduce hippocampal subfield volumes but not cortical thickness in children with focal onset seizures. Epilepsy Res 2022; 179:106848. [PMID: 34992023 DOI: 10.1016/j.eplepsyres.2021.106848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Whether febrile seizures (FS) produce long-term injury to the hippocampus or other brain structures is a critical question concerning focal onset seizures in children. Our aims are to evaluate the effect of FS on subfields of the hippocampus, thalamic nuclei, amygdala, cortical thickness, and surface area quantitatively in children with FS who later developed focal seizures and to identify biomarkers based on MRI structures. METHODS Children who had focal onset seizures with or without previous FS and normal 3-T MRI findings were included retrospectively. The MRI was performed within 2 years after the onset of focal seizures. Age-matched controls were also recruited. Hippocampal subfields and thalamic nuclei, amygdala volumes, cortical thickness, and cortical surface area in individual cortical regions were segmented by FreeSurfer version 7.1.1. Volumetric and morphometric data among children who had focal seizures with or without previous FS, as well as controls, were compared and correlated with clinical parameters. RESULTS Children with a history of FS who had focal seizures exhibited smaller right cornu ammonis (CA) 1 and right molecular cell layer of the hippocampus, compared to those without FS. A larger left hippocampal fissure was also found in FS with focal seizures compared to age-matched controls. There were no statistically significant differences in each nucleus of the thalamus, amygdala, cortical thickness, and surface area of each cortical region among the three groups. A smaller whole hippocampal volume was found for the right hippocampus in children with FS and focal seizures compared to those without FS. A trend of negative correlation was found between the frequency of FS and the left and right CA1 subfield volume ratios of the hippocampus. CONCLUSIONS We concluded that multiple episodes of FS may be associated with a trivial difference in volume reduction in the CA1 and molecular layer of the right hippocampus and an enlarged hippocampal fissure of the left hippocampus, but not with individual cortical thicknesses, surface area, thalamic nuclei, or amygdala in children with focal onset seizures.The hippocampal subfield CA1 and molecular layer of the right hippocampus may be more vulnerable than the cortices in children with focal seizures who experienced multiple FS episodes. This study highlights the minimal differences in brain volumes among children with recent onset focal seizures with or without FS history and controls, suggesting that the brain injurious aspects of the FS and recent onset focal seizures may have been previously overstated. This suggests that physicians can be reassuring about brain injury associated with these seizure types when discussing outcomes with parents and patients.
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Affiliation(s)
- Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kevin Li-Chun Hsieh
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Min-Lan Tsai
- Division of Pediatric Neurology, Department of Pediatrics, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Tai-Tong Wong
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsi Chang
- Division of Pediatric Neurology, Department of Pediatrics, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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10
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Ayas S, Kurtish SY, Tanrıverdi T, Yeni SN. Evaluation of patients with late-onset and medically refractory temporal lobe epilepsy with mesial temporal sclerosis. Clin Neurol Neurosurg 2020; 198:106209. [PMID: 32987311 DOI: 10.1016/j.clineuro.2020.106209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Our study aims to compare demographics, clinical features and postsurgical outcomes between early and late-onset patients with medically refractory temporal lobe epilepsy (TLE) related to mesial temporal sclerosis (MTS). PATIENTS AND METHODS Seventy-one patients admitting to the Epilepsy Clinic of Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine between 1995-2015, who were diagnosed with refractory TLE related to MTS, were included in our study. All of these patients were resistant to medical treatment, and thus candidates for, or underwent surgery, and had no pathology other than MTS in their cranial magnetic resonance imaging (MRI). Based on previous studies, those patients were divided into two categories as "early-onset" and "late-onset", according to the age-onset of afebrile recurrent seizures, where the cutoff was determined as 20 years. Demographics, clinical features, and postsurgical outcomes were compared between both groups. RESULTS Fifty-three patients included in our study had early-onset MTS-TLE, and 18 patients had late-onset MTS-TLE. Demographics, clinical features, characteristics of electroencephalography (EEG), MRI, PET MRI/CT, neuropsychometric test (NPT) and postsurgical outcomes were similar in both groups. CONCLUSION In both the early-onset and late-onset groups, the presence of similar demographics, clinical features, and postoperative outcomes have suggested that the course of the disease and the success of surgical treatment were not associated with the age-onset of seizures in TLE related to MTS.
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Affiliation(s)
- Selahattin Ayas
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Neurology, Istanbul, Turkey.
| | - Selin Yağcı Kurtish
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine Department of Neurosurgery, Istanbul, Turkey
| | - Taner Tanrıverdi
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine Department of Neurosurgery, Istanbul, Turkey
| | - Seher Naz Yeni
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Neurology, Istanbul, Turkey
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11
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An image processing algorithm to aid diagnosis of mesial temporal sclerosis in children: a case-control study. Pediatr Radiol 2020; 50:98-106. [PMID: 31578627 DOI: 10.1007/s00247-019-04518-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/22/2019] [Accepted: 08/28/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Mesial temporal sclerosis (MTS) is an important cause of intractable epilepsy. Early and accurate diagnosis of MTS is essential to providing curative and life-changing therapy but can be challenging in children in whom the impact of diagnosis is particularly high. Magnetic resonance imaging (MRI) plays an important role in the diagnosis of MTS, and image processing of MRI is a recently studied strategy to improve its accuracy. OBJECTIVE In a retrospective case-control study, we assessed the performance of an image processing algorithm (Correlative Image Enhancement [CIE]) for detecting MTS-related hippocampal signal abnormality in children. MATERIALS AND METHODS Twenty-seven pediatric MTS cases (9 males, 18 females; mean age: 16±standard deviation [SD] 6.7 years) were identified from a pathology database of amygdylo-hippocampectomies performed in children with epilepsy. Twenty-seven children with no seizure history (9 males, 18 females; mean age: 13.8±SD 2.8 years), and with normal brain MRI, were identified for the control group. Blinded investigators processed the MRI coronal FLAIR (fluid-attenuated inversion recovery) images with CIE, saved the processed images as a separate series, and made equivalent region of interest measurements on the processed and unprocessed series to calculate contrast-to-noise ratio. Six blinded reviewers then rated the randomized series for hippocampal signal abnormality and MTS disease status. RESULTS CIE increased signal intensity and contrast-to-noise ratio in 26/27 hippocampi with pathologically confirmed MTS (96.3%) with the mean (SD) contrast-to-noise ratio of cases increasing from 14.9 (11.1) to 77.7 (58.7) after processing (P<0.001). Contrast-to-noise ratio increased in 1/54 normal control hippocampi (1.9%), with no significant change in the mean contrast-to-noise ratio of the control group after processing (P=0.57). Mean (SD) reader sensitivity for detecting abnormal signal intensity increased from 83.3% (14.2) to 94.8% (3.3) after processing. Mean specificity for abnormal signal intensity increased from 94.4% (7.3) to 96.3% (0). While sensitivity improved after processing for detection of MTS disease status in 4/6 readers, the mean reader sensitivity and specificity for MTS detection increased only minimally after processing, from 79.6% to 80.7% and from 95.7% to 96.3%, respectively. CONCLUSION The CIE image processing algorithm selectively increased the contrast-to-noise ratio of hippocampi affected by MTS, improved reader performance in detecting MTS-related hippocampal signal abnormality and could have high impact on pediatric patients undergoing work-up for seizures.
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Yokoi S, Kidokoro H, Yamamoto H, Ohno A, Nakata T, Kubota T, Tsuji T, Morishita M, Kawabe T, Naiki M, Maruyama K, Itomi K, Kato T, Ito K, Natsume J. Hippocampal diffusion abnormality after febrile status epilepticus is related to subsequent epilepsy. Epilepsia 2019; 60:1306-1316. [DOI: 10.1111/epi.16059] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/12/2019] [Accepted: 05/13/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Setsuri Yokoi
- Department of Pediatrics Nagoya University Graduate School of Medicine Nagoya Japan
| | - Hiroyuki Kidokoro
- Department of Pediatrics Nagoya University Graduate School of Medicine Nagoya Japan
- Brain and Mind Research Center Nagoya University Nagoya Japan
| | - Hiroyuki Yamamoto
- Department of Pediatrics Nagoya University Graduate School of Medicine Nagoya Japan
| | - Atsuko Ohno
- Department of Pediatrics Nagoya University Graduate School of Medicine Nagoya Japan
| | - Tomohiko Nakata
- Department of Pediatrics Nagoya University Graduate School of Medicine Nagoya Japan
| | - Tetsuo Kubota
- Department of Pediatrics Anjo Kosei Hospital Anjo Japan
| | - Takeshi Tsuji
- Department of Pediatrics Okazaki City Hospital Okazaki Japan
| | | | - Takashi Kawabe
- Department of Pediatrics Kasugai Municipal Hospital Kasugai Japan
| | - Misako Naiki
- Department of Pediatrics Kasugai Municipal Hospital Kasugai Japan
| | - Koichi Maruyama
- Department of Pediatric Neurology Aichi Prefectural Colony Central Hospital Kasugai Japan
| | - Kazuya Itomi
- Department of Neurology Aichi Children's Health and Medical Center Obu Japan
| | - Toru Kato
- Department of Pediatrics Okazaki City Hospital Okazaki Japan
| | - Komei Ito
- Department of Allergology Aichi Children's Health and Medical Center Obu Japan
| | - Jun Natsume
- Department of Pediatrics Nagoya University Graduate School of Medicine Nagoya Japan
- Brain and Mind Research Center Nagoya University Nagoya Japan
- Department of Pediatrics Japanese Red Cross Nagoya First Hospital Nagoya Japan
- Department of Developmental Disability Medicine Nagoya University Graduate School of Medicine Nagoya Japan
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13
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Guerriero RM, Gaillard WD. Imaging modalities to diagnose and localize status epilepticus. Seizure 2019; 68:46-51. [DOI: 10.1016/j.seizure.2018.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 01/07/2023] Open
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14
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Dahi F, Parsons MS, Orlowski HLP, Salter A, Dahiya S, Sharma A. Image Processing to Improve Detection of Mesial Temporal Sclerosis in Adults. AJNR Am J Neuroradiol 2019; 40:798-801. [PMID: 30948379 DOI: 10.3174/ajnr.a6022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/18/2019] [Indexed: 11/07/2022]
Abstract
In this retrospective case-control study, we investigated whether an image-processing algorithm designed to exaggerate the intensity of diseased hippocampi on FLAIR images can improve the diagnostic accuracy and interobserver reliability of radiologists in detecting mesial temporal sclerosis-related hippocampal signal alteration. Herein, we share the results of this study that showed that the image processing improved the confidence of radiologists in detecting mesial temporal sclerosis-related signal alteration, allowing an improved sensitivity, specificity, and interobserver reliability.
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Affiliation(s)
- F Dahi
- From the Progressive Physicians Association (F.D), Bethlehem, Pennsylvania
| | - M S Parsons
- Mallinckrodt Institute of Radiology (M.S.P., H.L.P.O., A.Sharma)
| | - H L P Orlowski
- Mallinckrodt Institute of Radiology (M.S.P., H.L.P.O., A.Sharma)
| | - A Salter
- Department of Biostatistics (A.Salter)
| | - S Dahiya
- Department of Pathology and Immunology (S.D.), Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - A Sharma
- Mallinckrodt Institute of Radiology (M.S.P., H.L.P.O., A.Sharma)
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15
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Thompson KW, Suchomelova L, Wasterlain CG. Treatment of early life status epilepticus: What can we learn from animal models? Epilepsia Open 2018; 3:169-179. [PMID: 30564776 PMCID: PMC6293069 DOI: 10.1002/epi4.12271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Treatment of status epilepticus (SE) in infants and children is challenging. There is a recognition that a broad set of developmental processes need to be considered to fully appreciate the physiologic complexity of severe seizures, and seizure outcomes, in infants and children. The development and use of basic models to elucidate important mechanisms will help further our understanding of these processes. Here we review some of the key experimental models and consider several areas relevant to treatment that could lead to productive translational research. Terminating seizures quickly is essential. Understanding pharmacoresistance of SE as it relates to receptor trafficking will be critical to seizure termination. Once a severe seizure is terminated, how will the developing brain respond? Basic studies suggest that there are important acute and long‐term histopathologic, and pathophysiologic, consequences that, if left unaddressed, will produce long‐lasting deficits on the form and function of the central nervous system. To fully utilize the evidence that basic models produce, age‐ and development‐ and model‐specific frameworks have to be considered carefully. Studies have demonstrated that severe seizures can cause perturbations to developmental processes during critical periods of development that lead to life‐long deficits. Unfortunately, some of the drugs that are commonly used to treat seizures may also produce negative outcomes by enhancing Cl‐‐mediated depolarization, or by accelerating programmed cell death. More research is needed to understand these phenomena and their relevance to the human condition, and to develop rational drugs that protect the developing brain from severe seizures to the fullest extent possible.
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Affiliation(s)
- Kerry W Thompson
- Department of Biology Occidental College Los Angeles California U.S.A
| | - Lucie Suchomelova
- Department of Neurology David Geffen School of Medicine at UCLA Los Angeles California U.S.A
| | - Claude G Wasterlain
- VA Greater Los Angeles Health Care System Los Angeles California U.S.A.,Department of Neurology David Geffen School of Medicine at UCLA Los Angeles California U.S.A.,Brain Research Institute UCLA Los Angeles California U.S.A
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16
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Curran MM, Haddad E, Patterson KP, Choy M, Dubé CM, Baram TZ, Obenaus A. Epilepsy-predictive magnetic resonance imaging changes following experimental febrile status epilepticus: Are they translatable to the clinic? Epilepsia 2018; 59:2005-2018. [PMID: 30256385 DOI: 10.1111/epi.14561] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE A subset of children with febrile status epilepticus (FSE) are at risk for development of temporal lobe epilepsy later in life. We sought a noninvasive predictive marker of those at risk that can be identified soon after FSE, within a clinically realistic timeframe. METHODS Longitudinal T2 -weighted magnetic resonance imaging (T2 WI MRI) of rat pups at several time points after experimental FSE (eFSE) was performed on a high-field scanner followed by long-term continuous electroencephalography. In parallel, T2 WI MRI scans were performed on a 3.0-T clinical scanner. Finally, chronic T2 WI MRI signal changes were examined in rats that experienced eFSE and were imaged months later in adulthood. RESULTS Epilepsy-predicting T2 changes, previously observed at 2 hours after eFSE, persisted for at least 6 hours, enabling translation to the clinic. Repeated scans, creating MRI trajectories of T2 relaxation times following eFSE, provided improved prediction of epileptogenesis compared with a single MRI scan. Predictive signal changes centered on limbic structures, such as the basolateral and medial amygdala. T2 WI MRI changes, originally described on high-field scanners, can also be measured on clinical MRI scanners. Chronically elevated T2 relaxation times in hippocampus were observed months after eFSE in rats, as noted for post-FSE changes in children. SIGNIFICANCE Early T2 WI MRI changes after eFSE provide a strong predictive measure of epileptogenesis following eFSE, on both high-field and clinical MRI scanners. Importantly, the extension of the acute signal changes to at least 6 hours after the FSE enables its inclusion in clinical studies. Chronic elevations of T2 relaxation times within the hippocampal formation and related structures are common to human and rodent FSE, suggesting that similar processes are involved across species.
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Affiliation(s)
- Megan M Curran
- Department of Anatomy/Neurobiology, University of California, Irvine, Irvine, California
| | - Elizabeth Haddad
- Department of Pediatrics, University of California, Irvine, Irvine, California
| | - Katelin P Patterson
- Department of Anatomy/Neurobiology, University of California, Irvine, Irvine, California
| | - Mankin Choy
- Department of Anatomy/Neurobiology, University of California, Irvine, Irvine, California.,Department of Pediatrics, University of California, Irvine, Irvine, California
| | - Celine M Dubé
- Department of Pediatrics, University of California, Irvine, Irvine, California
| | - Tallie Z Baram
- Department of Anatomy/Neurobiology, University of California, Irvine, Irvine, California.,Department of Pediatrics, University of California, Irvine, Irvine, California.,Department of Neurology, University of California, Irvine, Irvine, California
| | - Andre Obenaus
- Department of Anatomy/Neurobiology, University of California, Irvine, Irvine, California.,Department of Pediatrics, University of California, Irvine, Irvine, California
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17
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Nagesh C, Kumar S, Menon R, Thomas B, Radhakrishnan A, Kesavadas C. The Imaging of Localization Related Symptomatic Epilepsies: The Value of Arterial Spin Labelling Based Magnetic Resonance Perfusion. Korean J Radiol 2018; 19:965-977. [PMID: 30174487 PMCID: PMC6082755 DOI: 10.3348/kjr.2018.19.5.965] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/19/2018] [Indexed: 11/15/2022] Open
Abstract
Accurate identification of the epileptogenic zone is an important prerequisite in presurgical evaluation of refractory epilepsy since it affects seizure-free outcomes. Apart from structural magnetic resonance imaging (sMRI), delineation has been traditionally done with electroencephalography and nuclear imaging modalities. Arterial spin labelling (ASL) sequence is a non-contrast magnetic resonance perfusion technique capable of providing similar information. Similar to single-photon emission computed tomography, its utility in epilepsy is based on alterations in perfusion linked to seizure activity by neurovascular coupling. In this article, we discuss complementary value that ASL can provide in the evaluation and characterization of some basic substrates underlying epilepsy. We also discuss the role that ASL may play in sMRI negative epilepsy and acute scenarios such as status epilepticus.
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Affiliation(s)
- Chinmay Nagesh
- Department of Imaging Sciences & Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum 695011, India
| | - Savith Kumar
- Department of Imaging Sciences & Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum 695011, India
| | - Ramshekhar Menon
- Comprehensive Epilepsy Centre, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum 695011, India
| | - Bejoy Thomas
- Department of Imaging Sciences & Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum 695011, India
| | - Ashalatha Radhakrishnan
- Comprehensive Epilepsy Centre, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum 695011, India
| | - Chandrasekharan Kesavadas
- Department of Imaging Sciences & Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum 695011, India
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18
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Mohammad H, Sekar S, Wei Z, Moien-Afshari F, Taghibiglou C. Perampanel but Not Amantadine Prevents Behavioral Alterations and Epileptogenesis in Pilocarpine Rat Model of Status Epilepticus. Mol Neurobiol 2018; 56:2508-2523. [PMID: 30039334 DOI: 10.1007/s12035-018-1230-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/08/2018] [Indexed: 12/26/2022]
Abstract
Pilocarpine-induced status epilepticus (SE), which results in the development of spontaneous recurrent seizures (SRSs) activates glutamatergic receptors that contribute to seizure sustenance and neuronal cell death. In the current study, we evaluate whether the exposure to perampanel, an α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor blocker, or amantadine, a N-methyl-D-aspartic acid (NMDA) receptor blocker would reduce the SE-induced long-term consequences. SE was induced in adult male Sprague Dawley rats with pilocarpine. Perampanel or amantadine was injected 10 or 60 min after SE onset. The efficacy of either, in overcoming pilocarpine-induced SE was assessed using electroencephalogram (EEG) recordings. In addition, alterations in cognitive function, development of spontaneous recurrent seizures (SRSs), and hippocampal damage that are generally encountered after SE were also assessed at 72 h and 5 weeks after the induction of SE. Our results indicate that both early and late treatment with perampanel but not amantadine significantly reduced seizure activity. Furthermore, perampanel but not amantadine, reversed the memory deficits in Y-maze and novel object recognition (NOR) tests and retarded the appearance of SRSs. Moreover, perampanel treatment led to reduced SE-induced caspase-3 activation in the hippocampal lysates. Taken together, the data obtained from the study reveals that blocking AMPA receptors by perampanel can modify SE-induced long-term consequences. Our results may provide a proof of principle for the potential therapeutic application of perampanel in clinical use for status epilepticus in future.
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Affiliation(s)
- Hanan Mohammad
- Department of Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, SK, S7N 5E5, Canada
| | - Sathiya Sekar
- Department of Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, SK, S7N 5E5, Canada
| | - Zelan Wei
- Department of Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, SK, S7N 5E5, Canada
| | - Farzad Moien-Afshari
- Department of Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, SK, S7N 5E5, Canada.
- Department of Medicine, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.
- Division of Neurology, Department of Medicine, University of British Colombia, 8247-2775 Laurel St, Vancouver, BC, V5Z 1M9, Canada.
| | - Changiz Taghibiglou
- Department of Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, SK, S7N 5E5, Canada.
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19
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Marawar R, Basha M, Mahulikar A, Desai A, Suchdev K, Shah A. Updates in Refractory Status Epilepticus. Crit Care Res Pract 2018; 2018:9768949. [PMID: 29854452 PMCID: PMC5964484 DOI: 10.1155/2018/9768949] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/19/2018] [Indexed: 01/01/2023] Open
Abstract
Refractory status epilepticus is defined as persistent seizures despite appropriate use of two intravenous medications, one of which is a benzodiazepine. It can be seen in up to 40% of cases of status epilepticus with an acute symptomatic etiology as the most likely cause. New-onset refractory status epilepticus (NORSE) is a recently coined term for refractory status epilepticus where no apparent cause is found after initial testing. A large proportion of NORSE cases are eventually found to have an autoimmune etiology needing immunomodulatory treatment. Management of refractory status epilepticus involves treatment of an underlying etiology in addition to intravenous anesthetics and antiepileptic drugs. Alternative treatment options including diet therapies, electroconvulsive therapy, and surgical resection in case of a focal lesion should be considered. Short-term and long-term outcomes tend to be poor with significant morbidity and mortality with only one-third of patients reaching baseline neurological status.
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Affiliation(s)
- Rohit Marawar
- Department of Neurology, Detroit Medical Center and Wayne State University, Detroit, MI 48201, USA
| | - Maysaa Basha
- Department of Neurology, Detroit Medical Center and Wayne State University, Detroit, MI 48201, USA
| | - Advait Mahulikar
- Department of Neurology, Detroit Medical Center and Wayne State University, Detroit, MI 48201, USA
| | - Aaron Desai
- Department of Neurology, Detroit Medical Center and Wayne State University, Detroit, MI 48201, USA
| | - Kushak Suchdev
- Department of Neurology, Detroit Medical Center and Wayne State University, Detroit, MI 48201, USA
| | - Aashit Shah
- Department of Neurology, Detroit Medical Center and Wayne State University, Detroit, MI 48201, USA
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20
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Adler S, Hong SJ, Liu M, Baldeweg T, Cross JH, Bernasconi A, Bernhardt BC, Bernasconi N. Topographic principles of cortical fluid-attenuated inversion recovery signal in temporal lobe epilepsy. Epilepsia 2018; 59:627-635. [PMID: 29383717 DOI: 10.1111/epi.14017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE In drug-resistant temporal lobe epilepsy (TLE), relative to the large number of whole-brain morphological studies, neocortical T2 changes have not been systematically investigated. The aim of this study was to assess the anatomical principles that govern the distribution of neocortical T2-weighted fluid-attenuated inversion recovery (FLAIR) signal intensity and uncover its topographic principles. METHODS Using a surface-based sampling scheme, we mapped neocortical FLAIR intensity of 61 TLE patients relative to 38 healthy controls imaged at 3 T. To address topographic principles of the susceptibility to FLAIR signal changes in TLE, we assessed associations with normative data on tissue composition using 2 complementary approaches. First, we evaluated whether the degree of TLE-related FLAIR intensity changes differed across cytoarchitectonic classes as defined by Von Economo-Koskinas taxonomy. Second, as a proxy to map regions with similar intracortical composition, we carried out a FLAIR intensity covariance paradigm in controls by seeding systematically from all cortical regions, and identified those networks that were the best spatial predictors of the between-group FLAIR changes. RESULTS Increased intensities were observed in bilateral limbic and paralimbic cortices (hippocampus, parahippocampus, cingulate, temporopolar, insular, orbitofrontal). Effect sizes were highest in periallocortical limbic and insular classes as defined by the Von Economo-Koskinas cytoarchitectonic taxonomy. Furthermore, systematic FLAIR intensity covariance analysis in healthy controls revealed that similarity patterns characteristic of limbic cortices, most notably the hippocampus, served as sensitive predictors for the topography of FLAIR hypersignal in patients. FLAIR intensity findings were robust against correction for morphological confounds. Patients with a history of febrile convulsions showed more marked signal changes in parahippocampal and retrosplenial cortices, known to be strongly connected to the hippocampus. SIGNIFICANCE FLAIR intensity mapping and covariance analysis provide a model of TLE gray matter pathology based on shared vulnerability of periallocortical and limbic cortices.
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Affiliation(s)
- Sophie Adler
- NeuroImaging of Epilepsy Laboratory, McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.,Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Seok-Jun Hong
- NeuroImaging of Epilepsy Laboratory, McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Min Liu
- NeuroImaging of Epilepsy Laboratory, McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Torsten Baldeweg
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - J Helen Cross
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Andrea Bernasconi
- NeuroImaging of Epilepsy Laboratory, McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Boris C Bernhardt
- NeuroImaging of Epilepsy Laboratory, McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.,Multimodal Imaging and Connectome Analysis Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Neda Bernasconi
- NeuroImaging of Epilepsy Laboratory, McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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Janz P, Schwaderlapp N, Heining K, Häussler U, Korvink JG, von Elverfeldt D, Hennig J, Egert U, LeVan P, Haas CA. Early tissue damage and microstructural reorganization predict disease severity in experimental epilepsy. eLife 2017; 6. [PMID: 28746029 PMCID: PMC5529108 DOI: 10.7554/elife.25742] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 06/13/2017] [Indexed: 12/17/2022] Open
Abstract
Mesial temporal lobe epilepsy (mTLE) is the most common focal epilepsy in adults and is often refractory to medication. So far, resection of the epileptogenic focus represents the only curative therapy. It is unknown whether pathological processes preceding epilepsy onset are indicators of later disease severity. Using longitudinal multi-modal MRI, we monitored hippocampal injury and tissue reorganization during epileptogenesis in a mouse mTLE model. The prognostic value of MRI biomarkers was assessed by retrospective correlations with pathological hallmarks Here, we show for the first time that the extent of early hippocampal neurodegeneration and progressive microstructural changes in the dentate gyrus translate to the severity of hippocampal sclerosis and seizure burden in chronic epilepsy. Moreover, we demonstrate that structural MRI biomarkers reflect the extent of sclerosis in human hippocampi. Our findings may allow an early prognosis of disease severity in mTLE before its first clinical manifestations, thus expanding the therapeutic window.
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Affiliation(s)
- Philipp Janz
- Experimental Epilepsy Research, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Niels Schwaderlapp
- Medical Physics, Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Heining
- Faculty of Biology, University of Freiburg, Freiburg, Germany.,Laboratory for Biomicrotechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - Ute Häussler
- Experimental Epilepsy Research, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
| | - Jan G Korvink
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Dominik von Elverfeldt
- Medical Physics, Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Hennig
- Medical Physics, Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
| | - Ulrich Egert
- Laboratory for Biomicrotechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany.,BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany.,Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Pierre LeVan
- Medical Physics, Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
| | - Carola A Haas
- Experimental Epilepsy Research, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany.,Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
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22
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Pujar SS, Seunarine KK, Martinos MM, Neville BGR, Scott RC, Chin RFM, Clark CA. Long-term white matter tract reorganization following prolonged febrile seizures. Epilepsia 2017; 58:772-780. [PMID: 28332711 PMCID: PMC5484997 DOI: 10.1111/epi.13724] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2017] [Indexed: 12/17/2022]
Abstract
Objective Diffusion magnetic resonance imaging (MRI) studies have demonstrated acute white matter changes following prolonged febrile seizures (PFS), but their longer‐term evolution is unknown. We investigated a population‐based cohort to determine white matter diffusion properties 8 years after PFS. Methods We used diffusion tensor imaging (DTI) and applied Tract‐Based Spatial Statistics for voxel‐wise comparison of white matter microstructure between 26 children with PFS and 27 age‐matched healthy controls. Age, gender, handedness, and hippocampal volumes were entered as covariates for voxel‐wise analysis. Results Mean duration between the episode of PFS and follow‐up was 8.2 years (range 6.7–9.6). All children were neurologically normal, and had normal conventional neuroimaging. On voxel‐wise analysis, compared to controls, the PFS group had (1) increased fractional anisotropy in early maturing central white matter tracts, (2) increased mean and axial diffusivity in several peripheral white matter tracts and late‐maturing central white matter tracts, and (3) increased radial diffusivity in peripheral white matter tracts. None of the tracts had reduced fractional anisotropy or diffusivity indices in the PFS group. Significance In this homogeneous, population‐based sample, we found increased fractional anisotropy in early maturing central white matter tracts and increased mean and axial diffusivity with/without increased radial diffusivity in several late‐maturing peripheral white matter tracts 8 years post‐PFS. We propose disruption in white matter maturation secondary to seizure‐induced axonal injury, with subsequent neuroplasticity and microstructural reorganization as a plausible explanation.
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Affiliation(s)
- Suresh S Pujar
- Neurosciences Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,Young Epilepsy, Lingfield, Surrey, United Kingdom
| | - Kiran K Seunarine
- Imaging and Biophysics Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Marina M Martinos
- Developmental Cognitive Neuroscience Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Brian G R Neville
- Neurosciences Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Young Epilepsy, Lingfield, Surrey, United Kingdom
| | - Rod C Scott
- Neurosciences Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,Young Epilepsy, Lingfield, Surrey, United Kingdom.,Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, Vermont, U.S.A
| | - Richard F M Chin
- Neurosciences Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Muir Maxwell Epilepsy Centre, Department of Child Life and Health, The University of Edinburgh, Edinburgh, United Kingdom
| | - Chris A Clark
- Imaging and Biophysics Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Asadi-Pooya AA, Nei M, Rostami C, Sperling MR. Mesial temporal lobe epilepsy with childhood febrile seizure. Acta Neurol Scand 2017; 135:88-91. [PMID: 26861129 DOI: 10.1111/ane.12566] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the demographic and clinical manifestations of patients with mesial temporal sclerosis and temporal lobe epilepsy (MTS-TLE) with childhood febrile seizure (FS) and establishing the potential differences as compared to those without FS. We also investigated the surgery outcome in these two groups of patients. MATERIALS AND METHODS In this retrospective study, all patients with a clinical diagnosis of drug-resistant TLE due to mesial temporal sclerosis, who underwent epilepsy surgery at Jefferson Comprehensive Epilepsy Center, were recruited. Patients were prospectively registered in a database from 1986 through 2014. Postsurgical outcome was classified into two groups; seizure-free or relapsed. Clinical manifestations and outcome were compared between patients with MTS-TLE with FS and those without FS. RESULTS Two hundred and sixty-two patients were eligible for this study. One hundred and seventy patients (64.9%) did not have FS in their childhood, while 92 patients (35.1%) reported experiencing FS in their childhood. Demographic and clinical characteristics of these two groups of patients were not different. Postoperative seizure outcome was not statistically different between these two groups of patients (P = 0.19). CONCLUSIONS When MTS is the pathological substrate of TLE, clinical manifestations and response to surgical treatment of patients are very similar in patients with history of febrile seizure in their childhood compared to those without such an experience. In other words, when the subgroup of patients with MTS-TLE and drug-resistant seizures is examined history of childhood febrile seizure loses its value as a distinguishing factor in characteristics or predictive factor for surgery outcome.
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Affiliation(s)
- A. A. Asadi-Pooya
- Jefferson Comprehensive Epilepsy Center; Department of Neurology; Thomas Jefferson University; Philadelphia PA USA
| | - M. Nei
- Jefferson Comprehensive Epilepsy Center; Department of Neurology; Thomas Jefferson University; Philadelphia PA USA
| | - C. Rostami
- Jefferson Comprehensive Epilepsy Center; Department of Neurology; Thomas Jefferson University; Philadelphia PA USA
| | - M. R. Sperling
- Jefferson Comprehensive Epilepsy Center; Department of Neurology; Thomas Jefferson University; Philadelphia PA USA
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Natsume J, Hamano SI, Iyoda K, Kanemura H, Kubota M, Mimaki M, Niijima S, Tanabe T, Yoshinaga H, Kojimahara N, Komaki H, Sugai K, Fukuda T, Maegaki Y, Sugie H. New guidelines for management of febrile seizures in Japan. Brain Dev 2017; 39:2-9. [PMID: 27613077 DOI: 10.1016/j.braindev.2016.06.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 06/11/2016] [Accepted: 06/13/2016] [Indexed: 12/01/2022]
Abstract
In 2015, the Japanese Society of Child Neurology released new guidelines for the management of febrile seizures, the first update of such guidelines since 1996. In 1988, the Conference on Febrile Convulsions in Japan published "Guidelines for the Treatment of Febrile Seizures." The Task Committee of the Conference proposed a revised version of the guidelines in 1996; that version released in 1996 was used for the next 19years in Japan for the clinical management of children with febrile seizures. Although the guidelines were very helpful for many clinicians, new guidelines were needed to reflect changes in public health and the dissemination of new medical evidence. The Japanese Society of Child Neurology formed a working group in 2012, and published the new guidelines in March 2015. The guidelines include emergency care, application of electroencephalography, neuroimaging, prophylactic diazepam, antipyretics, drugs needing special attention, and vaccines. While the new guidelines contain updated clinical recommendations, many unsolved questions remain. These questions should be clarified by future clinical research.
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Affiliation(s)
- Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Developmental Disability Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
| | - Kuniaki Iyoda
- Fukuyama Support Center of Development and Care for Children, Fukuyama, Japan
| | - Hideaki Kanemura
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Masaya Kubota
- Division of Neurology, National Center for Child Health and Development, Tokyo, Japan
| | - Masakazu Mimaki
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Shinichi Niijima
- Department of Pediatrics, Juntendo University Nerima Hospital, Tokyo, Japan
| | | | - Harumi Yoshinaga
- Department of Child Neurology, Okayama University Graduate Schools of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Noriko Kojimahara
- Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Hirohumi Komaki
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kenji Sugai
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tokiko Fukuda
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshihiro Maegaki
- Division of Child Neurology, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Hideo Sugie
- Faculty of Health and Medical Sciences, Tokoha University Hamamatsu Campus, Hamamatsu, Japan
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Weiss EF, Masur D, Shinnar S, Hesdorffer DC, Hinton VJ, Bonner M, Rinaldi J, de Water VV, Culbert J, Shinnar RC, Seinfeld S, Gallentine W, Nordli DR, Frank LM, Epstein L, Moshé SL, Sun S. Cognitive functioning one month and one year following febrile status epilepticus. Epilepsy Behav 2016; 64:283-288. [PMID: 27794237 PMCID: PMC5115943 DOI: 10.1016/j.yebeh.2016.09.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/20/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study was to determine early developmental and cognitive outcomes of children with febrile status epilepticus (FSE) one month and one year after FSE. METHODS One hundred ninety four children with FSE were evaluated on measures of cognition, receptive language, and memory as part of the FEBSTAT study and compared with 100 controls with simple febrile seizures (FSs). RESULTS Children with FSE did not differ dramatically on tasks compared with FS controls at one month after FSE but demonstrated slightly weaker motor development (p=0.035) and receptive language (p=0.034) at one year after FSE. Performances were generally within the low average to average range. Within the FSE cohort, non-White children performed weaker on many of the tasks compared with Caucasian children. At the one-year visit, acute hippocampal T2 findings on MRI were associated with weaker receptive language skills (p=0.0009), and human herpes virus 6 or 7 (HHV6/7) viremia was associated with better memory performances (p=0.047). CONCLUSION Febrile status epilepticus does not appear to be associated with significant cognitive impairment on early developmental measures, although there is a trend for possible receptive language and motor delay one year after FSE. Further follow-up, which is in progress, is necessary to track long-term cognitive functioning.
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Affiliation(s)
- Erica F Weiss
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States.
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Asadi-Pooya AA, Nei M, Sharan A, Sperling MR. Historical Risk Factors Associated with Seizure Outcome After Surgery for Drug-Resistant Mesial Temporal Lobe Epilepsy. World Neurosurg 2016; 89:78-83. [DOI: 10.1016/j.wneu.2016.02.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
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Asadi-Pooya AA, Nei M, Sharan A, Sperling MR. Patient Historical Risk Factors Associated with Seizure Outcome After Surgery for Drug-Resistant Nonlesional Temporal Lobe Epilepsy. World Neurosurg 2016; 91:205-9. [PMID: 27086259 DOI: 10.1016/j.wneu.2016.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/04/2016] [Accepted: 04/05/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the possible influence of risk factors on seizure outcome after surgery for drug-resistant nonlesional temporal lobe epilepsy (TLE). METHODS This retrospective study recruited patients with drug-resistant nonlesional TLE who underwent epilepsy surgery at Jefferson Comprehensive Epilepsy Center and were followed for a minimum of 1 year. Patients had been prospectively registered in a database from 1991 to 2014. Postsurgical outcome was classified into 2 groups: seizure free or relapsed. The possible risk factors influencing long-term seizure outcome after surgery were investigated. RESULTS Ninety-five patients (42 males and 53 females) were studied. Fifty-four (56.8%) patients were seizure free. Only a history of febrile seizure in childhood affected the risk of postoperative seizure recurrence (odds ratio, 0.22; 95% confidence interval, 0.06-0.83; P = 0.02). Gender, race, family history of epilepsy, history of status epilepticus, duration of disease before surgery, aura symptoms, IQ, and seizure type or frequency were not predictors of outcome. CONCLUSIONS Many patients with drug-resistant nonlesional TLE responded favorably to surgery. The only factor predictive of seizure outcome after surgery was a history of febrile seizure in childhood. It is critical to distinguish among different types of TLE when assessing outcome after surgery.
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Affiliation(s)
- Ali A Asadi-Pooya
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Maromi Nei
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ashwini Sharan
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael R Sperling
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Hippocampal Malrotation Is Associated With Prolonged Febrile Seizures: Results of the FEBSTAT Study. AJR Am J Roentgenol 2016; 205:1068-74. [PMID: 26496555 DOI: 10.2214/ajr.14.13330] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Hippocampal malrotation is characterized by incomplete hippocampal inversion with a rounded shape and blurred internal architecture. There is still debate about whether hippocampal malrotation has pathologic significance. We present findings from the Consequences of Prolonged Febrile Seizures in Childhood (FEBSTAT) study on the frequency of and risk factors for hippocampal malrotation. SUBJECTS AND METHODS FEBSTAT is a prospective multicenter study investigating the consequences of febrile status epilepticus in childhood. MRI studies of 226 patients with febrile status epilepticus were analyzed visually by two board-certified neuroradiologists blinded to clinical details and were compared with MRI studies of 96 subjects with first simple febrile seizure. Quantitative analysis of hippocampal volume was performed by two independent observers. RESULTS Hippocampal malrotation was present in 20 of 226 (8.8%) patients with febrile status epilepticus compared with two of 96 (2.1%) control subjects (odds ratio [OR], 4.56; 95% CI, 1.05-19.92). Hippocampal malrotation was exclusively left-sided in 18 of 22 (81.8%) patients and bilateral in the remaining four patients (18.2%). There was no case of exclusively right-sided hippocampal malrotation. Hippocampal malrotation was more common in boys than in girls (OR, 6.1; 95% CI, 1.7-21.5). On quantitative volumetric MRI analysis, the left hippocampal volume was smaller in patients with hippocampal malrotation than in control subjects with simple febrile seizure (p = 0.004), and the right-to-left hippocampal volume ratio was higher in the hippocampal malrotation group than in the simple febrile seizure group (p < 0.001). CONCLUSION Hippocampal malrotation is a developmental malformation that predominantly affects the left hippocampus in male patients and is more frequently found in children with prolonged febrile status epilepticus than in control subjects. These data provide further evidence that hippocampal malrotation represents a pathologic error in brain development rather than a normal variant.
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Rivas-Coppola MS, Shah N, Choudhri AF, Morgan R, Wheless JW. Chronological Evolution of Magnetic Resonance Imaging Findings in Children With Febrile Infection-Related Epilepsy Syndrome. Pediatr Neurol 2016; 55:22-9. [PMID: 26597039 DOI: 10.1016/j.pediatrneurol.2015.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/04/2015] [Accepted: 09/06/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To describe and analyze the chronological evolution of the radiological findings in seven children with febrile infection-related epilepsy syndrome. METHODS This is a retrospective study describing the radiological findings and evolution in seven children with febrile infection-related epilepsy syndrome who presented from 2009 to 2013. The children all fit the defined clinical criteria for febrile infection-related epilepsy syndrome; all had a history of normal psychomotor development who presented with acute-onset catastrophic partial status epilepticus associated with a febrile illness or unspecific infectious process. The children were identified from the author's weekly review of the pediatric inpatient service, and then the data were collected and analyzed retrospectively. RESULTS Six males and one female ranging from 3 months to 9 years of age presented with status epilepticus preceded by a febrile illness. Extensive investigations for infectious, autoimmune, and metabolic etiologies were unremarkable. Multiple antiepileptic medications were attempted, including drug-induced coma in all of them, with poor response. Immunotherapy with intravenous steroids or intravenous immunoglobulin (three patients had both) was tried in six of seven patients with a poor response. Ketogenic diet was initiated in four of seven patients with limited response. Serial magnetic resonance imaging studies, done from the initial presentation through 18 months of follow-up, showed evolution from normal imaging to severe cerebral atrophy. Progressive cytotoxic edema involving mostly bilateral hippocampi and temporal lobes was appreciated in one to three weeks. At one month from seizure onset, mild to moderate cerebral atrophy and hippocampal sclerosis was appreciated that continued to progress over the next year. After six to twelve months, most of the patients showed moderate to severe cerebral atrophy and by one year, cerebellar atrophy was also appreciated. CONCLUSION Febrile infection-related epilepsy syndrome is a devastating epilepsy syndrome of childhood without a diagnostic biologic marker. The magnetic resonance imaging findings appear to be progressive and typical. Thus, combined with the clinical course, imaging findings can help to confirm the diagnosis (until a biologic marker is found). This hopefully will allow multicentered treatment protocols in the future.
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Affiliation(s)
- Marianna S Rivas-Coppola
- Division of Pediatric Neurology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital - Neuroscience Institute, Memphis, Tennessee
| | - Namrata Shah
- Division of Pediatric Neurology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital - Neuroscience Institute, Memphis, Tennessee
| | - Asim F Choudhri
- Division of Pediatric Neurology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital - Neuroscience Institute, Memphis, Tennessee
| | - Robin Morgan
- Division of Pediatric Neurology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital - Neuroscience Institute, Memphis, Tennessee
| | - James W Wheless
- Division of Pediatric Neurology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital - Neuroscience Institute, Memphis, Tennessee.
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Imaging microstructural damage and plasticity in the hippocampus during epileptogenesis. Neuroscience 2015; 309:162-72. [DOI: 10.1016/j.neuroscience.2015.04.054] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/28/2015] [Accepted: 04/21/2015] [Indexed: 12/19/2022]
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Asadi-Pooya AA, Sperling MR. Age at onset in patients with medically refractory temporal lobe epilepsy and mesial temporal sclerosis: Impact on clinical manifestations and postsurgical outcome. Seizure 2015. [DOI: 10.1016/j.seizure.2015.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Byeon JH, Kim GH, Kim JY, Sun W, Kim H, Eun BL. Cognitive Dysfunction and Hippocampal Damage Induced by Hypoxic-Ischemic Brain Injury and Prolonged Febrile Convulsions in Immature Rats. J Korean Neurosurg Soc 2015; 58:22-9. [PMID: 26279809 PMCID: PMC4534735 DOI: 10.3340/jkns.2015.58.1.22] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 05/11/2015] [Accepted: 05/13/2015] [Indexed: 12/02/2022] Open
Abstract
Objective Perinatal hypoxic-ischemic encephalopathy (HIE) and prolonged febrile seizures (pFS) are common neurologic problems that occur during childhood. However, there is insufficient evidence from experimental studies to conclude that pFS directly induces hippocampal injury. We studied cognitive function and histological changes in a rat model and investigated which among pFS, HIE, or a dual pathologic effect is most detrimental to the health of children. Methods A rat model of HIE at postnatal day (PD) 7 and a pFS model at PD10 were used. Behavioral and cognitive functions were investigated by means of weekly open field tests from postnatal week (PW) 3 to PW7, and by daily testing with the Morris water maze test at PW8. Pathological changes in the hippocampus were observed in the control, pFS, HIE, and HIE+pFS groups at PW9. Results The HIE priming group showed a seizure-prone state. The Morris water maze test revealed a decline in cognitive function in the HIE and HIE+pFS groups compared with the pFS and control groups. Additionally, the HIE and HIE+pFS groups showed significant hippocampal neuronal damage, astrogliosis, and volume loss, after maturation. The pFS alone induced minimal hippocampal neuronal damage without astrogliosis or volume loss. Conclusion Our findings suggest that pFS alone causes no considerable memory or behavioral impairment, or cellular change. In contrast, HIE results in lasting memory impairment and neuronal damage, gliosis, and tissue loss. These findings may contribute to the understanding of the developing brain concerning conditions caused by HIE or pFS.
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Affiliation(s)
- Jung Hye Byeon
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Gun-Ha Kim
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Joo Yeon Kim
- Department of Anatomy and Division of Brain Korea 21 Biomedical Science, Korea University College of Medicine, Seoul, Korea
| | - Woong Sun
- Department of Anatomy and Division of Brain Korea 21 Biomedical Science, Korea University College of Medicine, Seoul, Korea
| | - Hyun Kim
- Department of Anatomy and Division of Brain Korea 21 Biomedical Science, Korea University College of Medicine, Seoul, Korea
| | - Baik-Lin Eun
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
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Hamelin S, Depaulis A. Revisiting hippocampal sclerosis in mesial temporal lobe epilepsy according to the "two-hit" hypothesis. Rev Neurol (Paris) 2015; 171:227-35. [PMID: 25748332 DOI: 10.1016/j.neurol.2015.01.560] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 01/20/2015] [Indexed: 12/28/2022]
Abstract
Hippocampal sclerosis (HS) is the most common neuropathological pattern observed in pharmacoresistant epilepsy and represents a critical feature in mesial temporal lobe epilepsy syndrome. However, its pathophysiological mechanisms and neuropathological consequences on seizures remain mostly unresolved. The new international classification of hippocampal sclerosis aims at standardizing its description to allow comparisons between different clinical studies. However, several aspects are not considered in this classification (granule cell dispersion, sprouting, glial modifications…). In this chapter, we discuss these different features associated with hippocampal sclerosis in perspective with the "two-hit" hypothesis and propose mechanisms that could be involved in the modulation of some specific neuropathological aspects like early life stress, hyperthermic seizures, brain lesions or hormonal modifications.
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Affiliation(s)
- S Hamelin
- Inserm, U836, université Joseph-Fourier, dite Santé, bâtiment Edmond-J.-Safra, chemin Fortuné-Ferrini, 38706 La Tronche cedex, France; University Grenoble-Alpes, Grenoble institut des neurosciences, chemin Fortuné-Ferrini, 38700 La Tronche, France; Hôpital Pierre-Oudot, 30, avenue du Médipôle, BP 40348, 38302 Bourgoin-Jallieu cedex, France.
| | - A Depaulis
- Inserm, U836, université Joseph-Fourier, dite Santé, bâtiment Edmond-J.-Safra, chemin Fortuné-Ferrini, 38706 La Tronche cedex, France; University Grenoble-Alpes, Grenoble institut des neurosciences, chemin Fortuné-Ferrini, 38700 La Tronche, France; CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
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Abstract
Patients with Temporal lobe epilepsy (TLE) frequently display cognitive comorbidity and can have widespread network abnormalities, which might affect a variety of cognitive and intellectual functions. As a result, refractory TLE seems to be associated with slow but ongoing cognitive deterioration. The case is of a 32 year old, right handed male, engineering graduate, diagnosed with TLE- right mesial, 12 years ago. A number of head injuries were caused due to the seizure present, which includes a fall from height of 12 feet in childhood. The neuropsychological tests administered were Gesell’s Drawing Test, Mini Mental State Examination, PGI Memory Scale, Battery of Performance Tests of Intelligence, Verbal Adult Intelligence Scale, Hamilton Rating Scale for Depression, Bender Visual Motor Gestalt Test and Dysfunction Analysis Questionnaire. No impairment found on orientation; average cognitive functioning; above average attention and concentration, verbal working memory, visual and verbal memory; average practical ability, abstract ability, average verbal intellectual ability; superior ability on comprehension and average performance ability. Mild to moderate impairment on perceptuo-motor functioning and an evidence of depression were present. Patient showed high dysfunction in personal, social, vocational and cognitive areas. The study highlights that even despite chronic epilepsy, with a series of head injuries due to the seizures; an individual can still have average neuropsychological abilities. Holistic neuropsychological rehabilitation along with Vocational Retraining would go a long way in the functional independence of the patient. Neuropsychologists have a significant role in the assessment, treatment, and rehabilitation of people with epilepsy.
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Abstract
PURPOSE OF REVIEW There is a long-standing hypothesis that febrile status epilepticus (FSE) can cause brain injury, particularly to the hippocampus. This review will evaluate recent evidence on the relationships between FSE and later epilepsy and cognitive impairments. Potential strategies for minimizing adverse outcomes will be discussed. RECENT FINDINGS There are two major longitudinal studies evaluating the outcomes for FSE. These studies provide evidence of acute hippocampal edema that evolves to mesial temporal sclerosis in a small number of children (∼7%). However, none of these children have developed temporal lobe epilepsy. There is also evidence of more global white matter injury. Development is affected, with a loss of about 10 developmental quotient points and there is evidence for accelerated forgetting. These findings do not correlate with MRI parameters. Therefore, FSE can cause a wide spectrum of injury, but the relationship between this and clinically relevant adverse outcomes remains uncertain. SUMMARY Although there is accumulating evidence that FSE can cause brain injury, the strategies to minimize the impact remain uncertain. Imaging requires sedation, with inherent risks, and may not be appropriate for all children with FSE, given the small number with significant hippocampal edema that could be a biomarker. The alternative of treating all children requires a very safe drug which currently does not exist.
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Perucca P, Camfield P, Camfield C. Does gender influence susceptibility and consequences of acquired epilepsies? Neurobiol Dis 2014; 72 Pt B:125-30. [DOI: 10.1016/j.nbd.2014.05.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/11/2014] [Accepted: 05/17/2014] [Indexed: 10/25/2022] Open
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Abstract
Convulsive status epilepticus is the most common neurological emergency in children and is associated with significant morbidity and mortality. The morbidities include later development of epilepsy, cognitive impairment, and psychiatric impairments. There has been a long-standing hypothesis that these outcomes are, at least in part, a function of brain injury induced by the status epilepticus. There is evidence from animal models and prospective human studies that the hippocampus may be injured during febrile status epilepticus although this pathophysiological sequence remains uncommon. Potential mechanisms include excitotoxicity, ischaemia, and inflammation. Neuroprotective drugs reduce brain injury but have little impact on epileptogenesis or cognitive impairments. Anti-inflammatory treatments have given mixed results to date. Broad-spectrum anti-inflammatory agents, such as steroids, are potentially harmful, whereas prevention of leucocyte diapedesis across the blood brain barrier appears to have a positive outcome. Therefore, more studies dissecting the inflammatory process are required to establish the most effective strategies for translation into clinical practice. In addition to neuronal loss, cognitive impairments are related to neuronal re-organisation and disruption of neural networks underpinning cognition. Further understanding of these mechanisms may lead to novel therapies that prevent brain injury, but also therapies that may improve outcomes even if injury has occurred.
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Affiliation(s)
- Rod C Scott
- Department of Neurological Science, University of Vermont College of Medicine, Burlington, VT 05405, USA
- Neurosciences Unit, UCL Institute of Child Health, London, UK
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Abstract
Epilepsy is one of the most common chronic neurological conditions worldwide. Anti-epileptic drugs (AEDs) can suppress seizures, but do not affect the underlying epileptic state, and many epilepsy patients are unable to attain seizure control with AEDs. To cure or prevent epilepsy, disease-modifying interventions that inhibit or reverse the disease process of epileptogenesis must be developed. A major limitation in the development and implementation of such an intervention is the current poor understanding, and the lack of reliable biomarkers, of the epileptogenic process. Neuroimaging represents a non-invasive medical and research tool with the ability to identify early pathophysiological changes involved in epileptogenesis, monitor disease progression, and assess the effectiveness of possible therapies. Here we will provide an overview of studies conducted in animal models and in patients with epilepsy that have utilized various neuroimaging modalities to investigate epileptogenesis.
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Affiliation(s)
- Sandy R Shultz
- Department of Medicine, The Melbourne Brain Centre, The Royal Melbourne Hospital, The University of Melbourne, Building 144, Royal Parade, Parkville, VIC, 3010, Australia,
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Lewis DV, Shinnar S, Hesdorffer DC, Bagiella E, Bello JA, Chan S, Xu Y, MacFall J, Gomes WA, Moshé SL, Mathern GW, Pellock JM, Nordli DR, Frank LM, Provenzale J, Shinnar RC, Epstein LG, Masur D, Litherland C, Sun S. Hippocampal sclerosis after febrile status epilepticus: the FEBSTAT study. Ann Neurol 2014; 75:178-85. [PMID: 24318290 DOI: 10.1002/ana.24081] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 10/30/2013] [Accepted: 11/18/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Whether febrile status epilepticus (FSE) produces hippocampal sclerosis (HS) and temporal lobe epilepsy (TLE) has long been debated. Our objective is to determine whether FSE produces acute hippocampal injury that evolves to HS. METHODS FEBSTAT and 2 affiliated studies prospectively recruited 226 children aged 1 month to 6 years with FSE and controls with simple febrile seizures. All had acute magnetic resonance imaging (MRI), and follow-up MRI was obtained approximately 1 year later in the majority. Visual interpretation by 2 neuroradiologists informed only of subject age was augmented by hippocampal volumetrics, analysis of the intrahippocampal distribution of T2 signal, and apparent diffusion coefficients. RESULTS Hippocampal T2 hyperintensity, maximum in Sommer's sector, occurred acutely after FSE in 22 of 226 children in association with increased volume. Follow-up MRI obtained on 14 of the 22 with acute T2 hyperintensity showed HS in 10 and reduced hippocampal volume in 12. In contrast, follow-up of 116 children without acute hyperintensity showed abnormal T2 signal in only 1 (following another episode of FSE). Furthermore, compared to controls with simple febrile seizures, FSE subjects with normal acute MRI had abnormally low right to left hippocampal volume ratios, smaller hippocampi initially, and reduced hippocampal growth. INTERPRETATION Hippocampal T2 hyperintensity after FSE represents acute injury often evolving to a radiological appearance of HS after 1 year. Furthermore, impaired growth of normal-appearing hippocampi after FSE suggests subtle injury even in the absence of T2 hyperintensity. Longer follow-up is needed to determine the relationship of these findings to TLE.
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Affiliation(s)
- Darrell V Lewis
- Department of Pediatrics (Neurology), Duke University Medical Center, Durham, NC
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Rajab E, Abdeen Z, Hassan Z, Alsaffar Y, Mandeel M, Al Shawaaf F, Al-Ansari S, Kamal A. Cognitive performance and convulsion risk after experimentally-induced febrile-seizures in rat. Int J Dev Neurosci 2014; 34:19-23. [PMID: 24433986 DOI: 10.1016/j.ijdevneu.2014.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/04/2014] [Accepted: 01/04/2014] [Indexed: 02/05/2023] Open
Abstract
Many reports indicated that small percentage of children with febrile seizures develop epilepsy and cognitive disorders later in adulthood. In addition, the neuronal network of the hippocampus was reported to be deranged in adult animals after being exposed to hyperthermia-induced seizures in their neonatal life. The aims of this study were to investigate (1) latency and probability of seizures, (2) spatial learning and memory, in adult rats after neonatal hyperthermia-induced febrile seizures (FS). Prolonged FS were elicited in 10-day old, male Sprague Dawleys (n=11/group) by exposure to heated air (48-52 °C) for 30 min; control rats were exposed to 30 °C air. After 1.5 months the animal's cognitive performance was assessed by 5 day trial in the Morris water maze. In another experiment the latency and probability of seizures were measured in response to pentylenetetrazole (PTZ) injections (increased doses ranged from 7 to 140 mg/kg; i.p.). In water maze, both groups showed improvements in escape latency and distance swam to reach the platform; effects were significantly greater in control versus hyperthermia-treated animals on days 3 and 4. Latency and probability of PTZ-induced seizures were shorter and higher respectively, in hyperthermia-treated animals compared to controls. We concluded that FS in neonatal rats leads to enhanced susceptibility for seizures, as well as cognitive deficits in adults.
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Affiliation(s)
- Ebrahim Rajab
- College of Medical & Health Sciences, Ahlia University, P.O. Box 10878, Manama, Bahrain
| | - Zahra Abdeen
- Physiology Department, College of Medicine and Medical Sciences, Arabian Gulf University, P.O. Box 22979, Manama, Bahrain
| | - Zuhair Hassan
- Physiology Department, College of Medicine and Medical Sciences, Arabian Gulf University, P.O. Box 22979, Manama, Bahrain
| | - Yousif Alsaffar
- Physiology Department, College of Medicine and Medical Sciences, Arabian Gulf University, P.O. Box 22979, Manama, Bahrain
| | - Mohammad Mandeel
- Physiology Department, College of Medicine and Medical Sciences, Arabian Gulf University, P.O. Box 22979, Manama, Bahrain
| | - Fatima Al Shawaaf
- Physiology Department, College of Medicine and Medical Sciences, Arabian Gulf University, P.O. Box 22979, Manama, Bahrain
| | - Sali Al-Ansari
- University Medical Centre of Groningen (UMCG), Groningen University, The Netherlands
| | - Amer Kamal
- Physiology Department, College of Medicine and Medical Sciences, Arabian Gulf University, P.O. Box 22979, Manama, Bahrain.
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Yoong M, Martinos MM, Chin RF, Clark CA, Scott RC. Hippocampal volume loss following childhood convulsive status epilepticus is not limited to prolonged febrile seizures. Epilepsia 2013; 54:2108-15. [PMID: 24304434 PMCID: PMC4377099 DOI: 10.1111/epi.12426] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2013] [Indexed: 12/04/2022]
Abstract
Purpose Childhood convulsive status epilepticus (CSE), in particular prolonged febrile seizures (PFS), has been linked with mesial temporal sclerosis (MTS). Previous studies have shown that hippocampal injury occurs in the acute phase immediately following CSE, but little is known about the longer term evolution of such injury. This study aimed to investigate the longer term outcome of childhood CSE with sequential magnetic resonance imaging (MRI) looking for progressive hippocampal injury during the first year post-CSE. Methods Eighty children (0.18–15.5 years) underwent brain MRI 1 month post-CSE, 50 with a repeat MRI at 6 months and 46 with repeat MRI at 12 months post-CSE. Thirty-one control subjects without neurologic problems had a single brain MRI for comparison. Hippocampal volumes were measured from each MRI scan by two independent observers, and hippocampal growth rates were estimated in each patient with suitable imaging. Key Findings Hippocampal volume loss was found in 20–30% of patients and was not associated with the etiology or clinical features of CSE, including seizure duration or focality. A borderline association was found between a history of previous seizures (p = 0.063) and the number of previous febrile seizures (p = 0.051), suggesting that multiple insults may be important in the pathogenesis of progressive hippocampal injury. Significance It is apparent that progressive hippocampal damage can occur after CSE of any etiology and is not limited to PFS. Repeated seizures may play an important role, but further follow-up is needed to determine any other risk factors and proportion of children showing initial volume loss progress to clinical MTS and temporal lobe epilepsy.
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Affiliation(s)
- Michael Yoong
- Neurosciences Unit, UCL Institute of Child Health, London, United Kingdom; Imaging and Biophysics Unit, UCL Institute of Child Health, London, United Kingdom; Young Epilepsy, Lingfield, Surrey, United Kingdom
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Yoong M, Seunarine K, Martinos M, Chin RF, Clark CA, Scott RC. Prolonged febrile seizures cause reversible reductions in white matter integrity. NEUROIMAGE-CLINICAL 2013; 3:515-21. [PMID: 24273734 PMCID: PMC3830064 DOI: 10.1016/j.nicl.2013.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 10/03/2013] [Accepted: 10/17/2013] [Indexed: 11/24/2022]
Abstract
Prolonged febrile seizures (PFS) are the commonest cause of childhood status epilepticus and are believed to carry a risk of neuronal damage, in particular to the mesial temporal lobe. This study was designed to determine: i) the effect of prolonged febrile seizures on white matter and ii) the temporal evolution of any changes seen. 33 children were recruited 1 month following PFS and underwent diffusion tensor imaging (DTI) with repeat imaging at 6 and 12 months after the original episode of PFS. 18 age-matched healthy control subjects underwent similar investigations at a single time point. Tract-based spatial statistics (TBSS) was used to compare fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) between patients and controls on a voxel-wise basis within the white matter skeleton. Widespread reductions in FA along multiple white matter tracts were found at 1 and 6 months post-PFS, but these had resolved at 12 months. At one month post-PFS the main changes seen were reductions in AD but at 6 months these had predominantly changed to increases in RD. These widespread white matter changes have not previously been noted following PFS. There are many possible explanations, but one plausible hypothesis is that this represents a temporary halting of normal white matter development caused by the seizure, that then resumes and normalises in the majority of children. Widespread reductions in FA occur in children after prolonged febrile seizures. These reductions persist up to 6 months post-PFS but resolve by 1 year. This may represent a seizure-related disruption of white matter development.
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Affiliation(s)
- M Yoong
- Neurosciences Unit, UCL Institute of Child Health, 4/5 Long Yard, London WC1N 3LU, UK ; Imaging and Biophysics Unit, UCL Institute of Child Health, 30 Guilford Street, London WC1N 2AP, UK ; Young Epilepsy, Lingfield, Surrey, UK ; Edinburgh Neurosciences, The University of Edinburgh, Muir Maxwell Epilepsy Centre, Edinburgh, UK
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Cell death and survival mechanisms are concomitantly active in the hippocampus of patients with mesial temporal sclerosis. Neuroscience 2013; 237:56-65. [DOI: 10.1016/j.neuroscience.2013.01.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/18/2013] [Accepted: 01/19/2013] [Indexed: 11/24/2022]
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Woermann FG, Vézina G. Structural imaging in children with chronic focal epilepsy: diagnostic algorithms and exploration strategies. HANDBOOK OF CLINICAL NEUROLOGY 2013; 111:747-57. [PMID: 23622222 DOI: 10.1016/b978-0-444-52891-9.00077-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Malformations of cortical development, especially focal cortical dysplasia in infants and children, and hippocampal sclerosis in adolescents with epilepsy are frequent lesions, but they are overlooked on standard MRI. In infants, errors in the interpretation of MRI in epilepsy can be attributed to MRI signal changes due to ongoing myelination. Poor technique, perceptual misses, incomplete knowledge and poor judgment are, however, other likely sources of errors when reading MRIs. This review covers MRI search strategies, i.e., how to conduct MRI examinations in epilepsy and what to expect in the structural MRI of an infant or child with focal epilepsy. Exploiting increased sensitivity, false positive results can be avoided in the light of a clinical hypothesis, possibly isolating a localized brain area by seizure semiology, EEG, and sometimes PET prior to MR reading.
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Hamad APA, Carrete H, Bianchin MM, Ferrari-Marinho T, Lin K, Yacubian EMT, Vilanova LCP, Garzon E, Caboclo LO, Sakamoto AC. Morphological variations of hippocampal formation in epilepsy: image, clinical and electrophysiological data. Epilepsy Behav 2013; 26:67-70. [PMID: 23220462 DOI: 10.1016/j.yebeh.2012.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 10/12/2012] [Accepted: 10/15/2012] [Indexed: 11/15/2022]
Abstract
Morphological variations of hippocampal formation (MVHF) are observed in patients with epilepsy but also in asymptomatic individuals. The precise role of these findings in epilepsy is not yet fully understood. This study analyzes the hippocampal formation (HF) morphology of asymptomatic individuals (n = 30) and of patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS) (n = 68), patients with malformations of cortical development (MCD) (n = 34), or patients with pure morphological variations of hippocampal formation (pure MVHF) (n = 12). Main clinical and electrophysiological data of patients with MVHF were also analyzed. Morphological variations of hippocampal formation are more frequently observed in patients with MCD than in patients with MTLE-HS or in asymptomatic individuals. Patients with pure morphological variations of hippocampal formation showed higher incidence of extratemporal seizure onset. Refractoriness seems to be more associated with other abnormalities, like HS or MCD, than with the HF variation itself. Thus, although morphological HF abnormalities might play a role in epileptogenicity, they seem to contribute less to refractoriness.
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Affiliation(s)
- Ana Paula Andrade Hamad
- Departamento de Neurologia e Neurocirurgia, Hospital São Paulo, Universidade Federal de São Paulo, Rua Napoleão de Barros, 865, Vila Clementino, São Paulo/SP, Brazil.
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Transient reduced diffusion in the cortex in a child with prolonged febrile seizures. Brain Dev 2012; 34:773-5. [PMID: 22236656 DOI: 10.1016/j.braindev.2011.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 12/08/2011] [Accepted: 12/13/2011] [Indexed: 11/20/2022]
Abstract
We report on a 4-year-old boy with transient reduced diffusion in the cortex, thalamus, and hippocampus on diffusion-weighted imaging (DWI) performed after prolonged febrile seizures (PFS). He had experienced intermittent right hemiconvulsions lasting about 90 min during the febrile illness, but his neurological symptom resolved completely after several hours. DWI performed immediately after the PFS showed abnormally high signal intensities in the left extended cortex and pulvinar of the ipsilateral thalamus. Two days later, these DWI lesions resolved completely, but abnormally high signal intensities were observed in the left hippocampus. Three months later, the DWI was normal, and no atrophy or gliosis was seen. This patient had unique lesions on DWI after PFS, but it is nevertheless important to attend to such lesions on the DWI of patients with PFS.
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Status epilepticus in children. HANDBOOK OF CLINICAL NEUROLOGY 2012. [PMID: 22939066 DOI: 10.1016/b978-0-444-52899-5.00028-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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Structural brain imaging. HANDBOOK OF CLINICAL NEUROLOGY 2012. [PMID: 22938982 DOI: 10.1016/b978-0-444-52898-8.00022-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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Hesdorffer DC, Shinnar S, Lewis DV, Moshé SL, Nordli DR, Pellock JM, MacFall J, Shinnar RC, Masur D, Frank LM, Epstein LG, Litherland C, Seinfeld S, Bello JA, Chan S, Bagiella E, Sun S. Design and phenomenology of the FEBSTAT study. Epilepsia 2012; 53:1471-80. [PMID: 22742587 DOI: 10.1111/j.1528-1167.2012.03567.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE Febrile status epilepticus (FSE) has been associated with hippocampal injury and subsequent hippocampal sclerosis (HS) and temporal lobe epilepsy. The FEBSTAT study was designed to prospectively examine the association between prolonged febrile seizures and development of HS and associated temporal lobe epilepsy, one of the most controversial issues in epilepsy. We report on the baseline phenomenology of the final cohorts as well as detailed aims and methodology. METHODS The "Consequences of Prolonged Febrile Seizures in Childhood" (FEBSTAT) study is a prospective, multicenter study. Enrolled are children, aged 1 month to 6 years of age, presenting with a febrile seizure lasting 30 min or longer based on ambulance, emergency department, and hospital records, and parental interview. At baseline, procedures included a magnetic resonance imaging (MRI) study and electroencephalography (EEG) recording done within 72 h of FSE, and a detailed history and neurologic examination. Baseline development and behavior are assessed at 1 month. The baseline assessment is repeated, with age-appropriate developmental testing at 1 and 5 years after enrollment as well as at the development of epilepsy and 1 year after that. Telephone calls every 3 months document additional seizures. Two other groups of children are included: a "control" group consisting of children with a first febrile seizure ascertained at Columbia University and with almost identical baseline and 1-year follow-up examinations and a pilot cohort of FSE from Duke University. KEY FINDINGS The FEBSTAT cohort consists of 199 children with a median age at baseline of 16.0 months (interquartile range [IQR] 12.0-24.0) and a median duration of FSE of 70.0 min (IQR 47.0-110.0). Seizures were continuous in 57.3% and behaviorally intermittent (without recovery in between) in 31.2%; most were partial (2.0%) or secondary generalized (65.8%), and almost all (98.0%) culminated in a generalized tonic-clonic seizure. Of the 199 children, 86.4% had normal development and 20% had prior febrile seizures. In one third of cases, FSE was unrecognized in the emergency department. The Duke existing cohort consists of 23 children with a median age of FSE onset of 18.0 months (IQR 14.0-28.0) and median duration of FSE of 90.0 min (IQR 50.0-170.0). The Columbia control cohort consists of 159 children with a first febrile seizure who received almost the same workup as the FEBSTAT cohort at baseline and at 1 year. They were followed by telephone every 4 months for a median of 42 months. Among the control cohort, 64.2% had a first simple FS, 26.4% had a first complex FS that was not FSE, and 9.4% had FSE. Among the 15 with FSE, the median age at onset was 14.0 months (IQR 12.0-20.0) and the median duration of FSE was 43.0 min (IQR 35.0-75.0). SIGNIFICANCE The FEBSTAT study presents an opportunity to prospectively study the relationship between FSE and acute hippocampal damage, the development of mesial temporal sclerosis, epilepsy (particularly temporal lobe epilepsy), and impaired hippocampal function in a large cohort. It is hoped that this study may illuminate a major mystery in clinical epilepsy today, and permit the development of interventions designed to prevent the sequelae of FSE.
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Affiliation(s)
- Dale C Hesdorffer
- GH Sergievsky Center, Columbia University, 630 West 168th Street, P & S Unit 16, New York, NY 10032, USA.
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Epstein LG, Shinnar S, Hesdorffer DC, Nordli DR, Hamidullah A, Benn EKT, Pellock JM, Frank LM, Lewis DV, Moshe SL, Shinnar RC, Sun S. Human herpesvirus 6 and 7 in febrile status epilepticus: the FEBSTAT study. Epilepsia 2012; 53:1481-8. [PMID: 22954016 DOI: 10.1111/j.1528-1167.2012.03542.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE In a prospective study, Consequences of Prolonged Febrile Seizures in Childhood (FEBSTAT), we determined the frequency of human herpesvirus (HHV)-6 and HHV-7 infection as a cause of febrile status epilepticus (FSE). METHODS Children ages 1 month to 5 years presenting with FSE were enrolled within 72 h and received a comprehensive assessment including specimens for HHV-6 and HHV-7. The presence of HHV-6A, HHV-6B, or HHV-7 DNA and RNA (amplified across a spliced junction) determined using quantitative polymerase chain reaction (qPCR) at baseline indicated viremia. Antibody titers to HHV-6 and HHV-7 were used in conjunction with the PCR results to distinguish primary infection from reactivated or prior infection. KEY FINDINGS Of 199 children evaluated, HHV-6 or HHV-7 status could be determined in 169 (84.9%). HHV-6B viremia at baseline was found in 54 children (32.0%), including 38 with primary infection and 16 with reactivated infection. No HHV-6A infections were identified. HHV-7 viremia at baseline was observed in 12 children (7.1%), including eight with primary infection and four with reactivated infection. Two subjects had HHV-6/HHV-7 primary coinfection at baseline. There were no differences in age, characteristics of illness or fever, seizure phenomenology or the proportion of acute EEG or imaging abnormalities in children presenting with FSE with or without HHV infection. SIGNIFICANCE HHV-6B infection is commonly associated with FSE. HHV-7 infection is less frequently associated with FSE. Together, they account for one third of FSE, a condition associated with an increased risk of both hippocampal injury and subsequent temporal lobe epilepsy.
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Affiliation(s)
- Leon G Epstein
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
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